05.11.10

Closing the "doughnut hole"

When I ran for the United States Senate in 2006 and during my travels around Rhode Island since then, I met countless seniors who are frustrated and confused by Medicare's prescription drug program, called "Medicare Part D." Specifically, Rhode Islanders are too often blindsided by the Part D coverage gap, or "doughnut hole," which exposes seniors to the full cost of prescription drugs after yearly drug expenses exceed $2,830. Drug coverage doesn't resume until they spend $6,440 for the year - a high threshold for seniors on low fixed incomes. This sudden and often unexpected rise in prescription costs can be devastating.

Seniors have told me how they are forced to skip doses because they can't afford a prescription refill. Choosing between paying for your medication and buying birthday presents for your grandchildren is a tough decision.

One of the most memorable stories came from a Woonsocket resident named Travis at one of my community dinners. His 90 year-old great-grandmother used to live independently in a walk-up apartment building in Woonsocket. One day, when she went to her pharmacy counter, her pharmacist told her that she was in the doughnut hole. When he told her what she had to pay for the full cost of her prescriptions, she walked home. She had to tell Travis that, because of this cost burden, she would no longer be able to afford her apartment and live independently. I often think what that walk home must have felt like for this proud 90 year-old lady.

No senior should have to choose between taking their medication and keeping the lights or the heat on. So I made a commitment that if I got to the U.S. Senate I would fight to close this coverage gap. Since 2007, I've sponsored legislation to accomplish this goal and urged my colleagues to action. During the recent debate on health care, I pressed for this change to be included in the larger reform bill. I can report to Rhode Islanders today that the health care legislation recently signed by President Obama takes immediate steps to help seniors who fall into the doughnut hole, and will ultimately fix the problem entirely.

For the 177,000 Rhode Island seniors on Medicare, health care reform will gradually, over the next ten years, entirely eliminate the doughnut hole for both brand name and generic drugs. Immediately, seniors will receive a $250 rebate whenever they fall into the doughnut hole. Starting in 2011, seniors will receive a 50% discount from pharmaceutical companies on brand name drugs purchased while in the doughnut hole. In 2013, the federal government will also pick up a share of those brand name drug costs, starting at 7% the first year and increasing to 25% by 2020. Combined with the 50% discount, that means seniors will receive full Part D coverage for brand name drugs by 2020. For generic drugs, the doughnut hole will begin to close in 2011, with the federal government picking up 7% of costs, increasing to 75% by 2020.

The health care reform bill also extends the solvency of Medicare by almost 10 years and allows our seniors to get access to free preventive services such as yearly checkups and screenings.

As we emerge from a year of wild rumors and false claims about health care legislation, and we begin to see the benefits of this historic measure, it will become increasingly clear that the passage of this bill was truly a victory for the people of Rhode Island - especially for our seniors.

Sheldon Whitehouse is the junior U.S. Senator for Rhode Island.


By:  Sheldon Whitehouse
Source: Kent County Daily Times